|
r-
<br /> r
<br /> I�
<br /> FOR OFf'!E USE tUtc urrt�e u�t ';,
<br /> 1,,J Pt.ICATION FOR SANITATION PERMIT t•'`
<br /> Per t N, ✓�
<br /> ICompletc '•ipll;ate) "''
<br /> l Dote Iswed�����
<br /> Th.: Pormit Expires 1 Year From Date Issued l
<br /> plication is hereby rnude to the Sen I,, I II cl!th Distrtrt fcr a Penna 10 Co•,struct and install the work hcrr+n dntrr t•�S
<br /> s application is made in compliun,,-- :y OrdifluncrNo/ 5-19 and errsting Rules c,nd Regulc:nom.
<br /> �,��'" c��,'.c,/j ,{/p� /rd•
<br /> 3 ADDRESS/LOCATIONCENSUS TRACTp �Lf'�
<br /> n t
<br /> Pnone t
<br />,net s Name
<br /> O � CitS,-,eA Zip
<br /> dressSfgJa-, WY-311� Phone
<br /> ntractor's Name License #0 �
<br /> Zbb ��16nI ,
<br /> tallation will serve: Res dence purtrnent House !_I Commerciul'li Trailer Court [.1
<br /> i . Oth,•r
<br /> mber of living units: Number of ! s Garbage Gander . lot $is*..
<br /> Pnvute I
<br /> at:•r Supply: Pudiic system 01id nume
<br /> orocter of soil to a depth of 3 fent: Son:l `_,,It Ll Clay[ Peat Q Sandy loam[) Clay loam I':]
<br /> Hardpan 1.II Material . If yes,type.... ...... .. .
<br /> _ _ -•aa...w-.: _.:.,:ileaswriwww+�^xR•+''"'�t"s'x.`.wWr.1xa.:yw•irM '-•`_._
<br /> of plan, showing size of lot, lowhon of .; rclutiott to wells, buildinys, eh•, ri►it be cloced on reverse side I
<br />'V; INSTALLATION: (No septic 1LMk i•r r +:, ptl pernuttud if pc,1,'iC ss wn+ is uvailublo within 200 !001,1 _
<br />,,CKAGE TREATMENT ( j SEPTIC TANK !u? Size lrq„uf Depth�s�, 2—
<br /> Capacity
<br /> Capacity �2 C� �'�c7' Materini W'v�• No. Compartments
<br /> v
<br /> Distance to neuresr
<br /> Foundation Cie Prop. line / -
<br /> ACHING LINE (� No. of lines length of each lino qS Total length �J 0
<br />-- V Tyre ; Material 5. le, Depth Flhwr Material /49
<br /> .#.
<br /> Distanu•to neuresr �' ,•n foundation /� Property Lint.
<br /> r +' Roc"A rifled Yes No
<br />;FPAGE PIT [� Depth A�•� Dtan•t•t••r Number 3I✓r x ,� '
<br /> Water Table Depth Rock Sipe -?A/ r '
<br /> Distance to neure,t
<br /> Foundation �C Prop. line S ;.
<br />.-PAIR/ADDITION (Prev. Sonitotion Pctrnit N - Dots 1
<br />,ptic Tank (Specify Requiremcrtsl
<br /> isposal Field [Specify Requirements)
<br /> !(` ,�,• , rut and required addition on reverse side)
<br /> hereby certify that I have prepared Ihis nhpli+„tion and that the work will be done in accordance with Son Joaquin Covnty .
<br /> rdinonces, State Lawc, and Rulei r,n.t •.+.intians of the Son Joaquin Local Health District, Home owner or licensed agents '
<br /> anoture crr•ttfies the fol'owinh, person In such manner as
<br /> certify that In the perfortnattce of ow work for which this permil is issued, 1 shall not employ any p
<br /> become subject to Workman's Coll,i-n�—;,,n laws of California.”
<br /> afore' / Owner
<br /> ,r} 1 �� Title fS7
<br /> trlsss-
<br /> (If other than owner) r
<br /> FAR D PAR
<br /> TME j�T E ONLY -
<br /> DAT f 7
<br /> PPUCATION ACCEFTED BY /' `
<br /> ,J DATE
<br /> IVISION OF LAND NUMBER
<br /> DID ITIONAL COMMENTS
<br /> I
<br /> Uate
<br /> S \ 1�I'r
<br /> 1 1
<br /> nal Insoectron by: 1 c �1 res aterr uv ,,,1 W
<br /> c)AQUIN LOCAL HEALTH DISTRICT
<br /> }
<br />
|